Shi Jiandang, Yue Xuefeng, Niu Ningkui, Zhao Chen, Qiu Hongyan, Wang Zili
Department of Spine Surgery, General Hospital of Ningxia Medical University, 804 Shengli Street, Xingqing District, Yinchuan, 750004, People's Republic of China.
Graduate School, Ningxia Medical University, Yinchuan, 750004, People's Republic of China.
Eur Spine J. 2017 Jul;26(7):1852-1861. doi: 10.1007/s00586-016-4917-2. Epub 2016 Dec 27.
In the present prospective randomized controlled study, we compared the feasibility and effectiveness of our modified thoracoabdominal approach to anterior thoracolumbar spine surgery without cutting open the costal portion of diaphragm (extradiaphragmatic approach) with the traditional transdiaphragmatic thoracoabdominal approach. The traditional combined thoracoabdominal approach in anterior thoracolumbar surgery for spine tuberculosis is effective but seriously damages the diaphragm and causes various lung complications. We used an extradiaphragmatic approach for complete anterior debridement, bone grafting, and nerve decompression and compared its efficacy and complications with those of the traditional transdiaphragmatic thoracolumbar approach.
The study included 106 patients with spinal tuberculosis. After a standard preoperative chemotherapy regimen, all patients underwent posterior deformity correction and internal fixation, anterior debridement, decompression, and bone grafting. Patients were divided into the modified extradiaphragmatic thoracolumbar approach group (the modified group) and the traditional transdiaphragmatic thoracolumbar approach group (the traditional group). During the treatment, we strictly followed the standard chemotherapy regimen.
The mean follow-up duration was 36.2 months (range 25-38 months). There were significant differences between the two groups in intraoperative blood loss, length of incision, recovery time, and postoperative complications but no significant differences in preoperative and postoperative erythrocyte sedimentation rates and C-reactive protein values, kyphosis, and neurologic function, recovery of ability to live and work, and postoperative healing of bone grafts.
The modified extradiaphragmatic thoracolumbar approach for anterior thoracolumbar spine surgery is as effective as the traditional approach. However, associated surgical trauma is minimal, and the incidence of pulmonary complications is low.
在本前瞻性随机对照研究中，我们比较了改良胸腹联合入路（不切开膈肌肋部，即膈外入路）与传统经膈肌胸腹联合入路用于胸腰段脊柱前路手术的可行性和有效性。脊柱结核前路胸腰段手术中传统的联合胸腹联合入路虽有效，但严重损伤膈肌并导致各种肺部并发症。我们采用膈外入路进行彻底的前路清创、植骨和神经减压，并将其疗效和并发症与传统经膈肌胸腰段入路进行比较。
本研究纳入106例脊柱结核患者。在进行标准的术前化疗方案后，所有患者均接受后路畸形矫正和内固定、前路清创、减压及植骨。患者被分为改良膈外胸腰段入路组（改良组）和传统经膈肌胸腰段入路组（传统组）。治疗期间，我们严格遵循标准化疗方案。
平均随访时间为36.2个月（范围25 - 38个月）。两组在术中出血量、切口长度、恢复时间和术后并发症方面存在显著差异，但术前和术后红细胞沉降率及C反应蛋白值、后凸畸形、神经功能、生活和工作能力恢复以及术后植骨愈合情况无显著差异。
改良膈外胸腰段入路用于胸腰段脊柱前路手术与传统入路效果相当。然而，相关手术创伤极小，肺部并发症发生率低。
